University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA.
University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA.
Gen Hosp Psychiatry. 2024 Sep-Oct;90:124-131. doi: 10.1016/j.genhosppsych.2024.08.003. Epub 2024 Aug 20.
Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center.
We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding.
A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.
围产期精神和焦虑障碍（PMADs）会导致不良的健康结果，但这些障碍往往未被识别和治疗不足。住院产科环境为行为健康的参与提供了独特的机会，包括筛查、简短治疗以及转介至门诊治疗。主动的联络-咨询（CL）模式已被证明在综合医院环境中是有效的，但在产科环境中研究甚少。本文介绍了在一家三级医疗中心的住院产科病房中实施和评估一种主动 CL 模式。
我们在一家住院产科病房实施了多学科主动 CL 模式，目的是识别有 PMAD 风险或正在经历 PMAD 的患者，并提供干预和/或转介治疗。在 17 个月的时间里，对 7322 名住院患者进行了系统筛查，以确定有行为健康咨询资格的患者。从电子病历中回顾性提取咨询数据。使用 RE-AIM 措施（可及性、有效性、采用、实施和维持）框架评估关键实施结果。
多学科团队共进行了 1589 次初始咨询，咨询率为 21.7%。大多数咨询（94%）由社会工作者或心理学家完成，大多数患者是在多学科轮诊时被确定需要咨询的（60.7%）。向精神科医生咨询的最常见原因包括药物管理、双相情感障碍病史和焦虑症病史。所有受邀的工作人员和提供者都参与了该模式。在试点资助结束后，有替代资金来源同意支付多学科团队的工资。
在住院产科病房实施的主动 CL 模式导致了更高的咨询率（21.7%），高于传统 CL 服务。多学科主动 CL 模式有望识别有 PMAD 风险的人群，并提供有针对性的干预措施，以预防 PMAD 并治疗有明显症状的患者。
